Over the last two decades, there has been a five-fold increase in annual funding for malaria research and development (R&D) – from $131 million in 1993 to $610 million in 2011. A cursory look at funding trends in the global battle against malaria reveals that much of the increase took place after 2004, when support stood at $320 million.
A report titled “From Pipeline to Product: Malaria R&D funding” by Policy Cures, an independent non-profit research group, with input and funding from several malaria-focused product development partnerships, projected that malaria R&D will require up to $8.3 billion over the next decade (2013-2022) to develop some new tools needed to sustain efforts to combat the disease.
With a midrange projection of about $700 million investment needed annually, malaria still kills about 660,000 people, mostly young children in Africa each year. The study warned that R&D investments are critical, given the emergence of drug resistance in the malaria parasite and insecticide resistance in the mosquito.
It is crucial to sustain the momentum created by an R&D pipeline that has never been healthier, with nearly 90 products in development, the report noted.
“This pipeline includes almost 40 drugs, 10 of which are in late-stage clinical trials; the first vaccine candidate to reach late-stage testing, with dozens of others in development; more than a dozen new mosquito control tools; and a host of new diagnostic tools.
“Among the interventions coming into widespread use over the past two decades are long-lasting insecticide-treated bed nets, artemisinin-based combination (drug) therapies for adults and children, and more rapid diagnostic tools,” the report stated.
Using these and other tools, malaria control efforts helped avert 274 million cases of malaria and 1.1 million deaths between 2000 and 2010.
About two-thirds of the projected funding needs for malaria R&D would be for new tools to support eradication, such as drugs that can completely eliminate parasites from infected patients, vaccines that can interrupt malaria transmission between humans and mosquitoes, vector control products that kill mosquitoes before they ever reach humans, and better diagnostic tools for health workers in the field, the report pointed out.
From Pipeline to Product used modelling to derive how the resource envelope might be allocated to maximise impact, with 32 percent going to vaccine R&D, 27 percent to drugs, 11 percent to mosquito control R&D, and 3 percent to diagnostics. The remainder, about 27 percent, would fund basic research to better understand the biology of malaria infection and transmission.
The report envisioned an array of new tools that could be available by 2022, if R&D funding meets projected needs. These include two new drugs, in a single dose, able to treat all types of malaria and prevent relapse; a drug that would provide a month of protection from all forms of malaria in a single dose; a first-generation vaccine against the Plasmodium falciparum malaria parasite that is 50 percent effective and lasts at least a year and possibly a more protective second-generation vaccine that prevents clinical disease and/or infection with one or both of falciparum and vivax malaria.
Other aspects of the new tools include three new active ingredients for killing mosquitoes that can be used in bed nets and indoor spraying campaigns; a field test for detecting low levels of parasites, an important tool for pursuing eradication and a healthy pipeline of backup products in all areas.
Achieving these product development goals is reliant on a very small group of donors: the top five donors – the Bill & Melinda Gates Foundation, the US National Institutes of Health (US NIH), industry, the European Commission (EC), and the US Department of Defence (US DOD) – account for almost three-quarters of funding for malaria R&D.
Only the Gates Foundation and US NIH have stepped up their funding, while the EC and US DOD experienced funding cuts through 2011, the last year of historical data in the report. Increasing the number of donors, as well as sustaining industry investment, is among the recommendations of the report.